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Managing Managing every mental disorder?

Vol. 1, No. 10 / October 2002

In his July editorial, Randy Hillard, MD, wrote: “Sometimes I envy pediatricians and geriatricians … these physicians need to know about and treat only one age group. As general psychiatrists, we must diagnose and treat every mental disorder from cradle to grave.”

Hopefully Dr. Hillard was only temporarily hypomanic or grandiose when he expressed that opinion. I respectfully recommend that he compare himself not with the medical age-group specialists but rather with the general practitioner.

Only television’s Marcus Welby, MD, seemed to treat everybody and every disorder, but I think I remember his seeking consultations with surgeons and other colleagues from time to time; I don’t think he delivered babies on the show.

Like a competent family doctor, a general psychiatrist must know his or her limits and refer or defer to colleagues appropriately. No one—except perhaps the grandiose or the hypomanic—should set such unrealistic expectations to diagnose and treat competently every mental disorder of every age group. Perhaps a little lithium would help abolish such a tyrannical notion!

Robert J. Alpern, MD
Atlanta, GA

Dr. Hillard responds

You are correct: I cannot treat ALL problems. For example, I recently referred a 95-year-old woman with multiple disorders.

I do believe, however, that psychiatrists need to keep track of many conditions. Maybe I am trying to keep track of too many.

Concerning your advice about lithium: I’d like to think I need psychotherapy rather than pharmacotherapy, but sometimes we are the last to know.

J. Randolph Hillard, MD

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